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General NPI Number Information
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NPI Number | 1194535757
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Entity Type | Individual
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Provider Name | KALIYAH JAHKEL BAILEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 2663 EASTERLY PL
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City | DECATUR
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State | GA
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Zip | 30035-4004
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Country | US
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Telephone | 770-981-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 348 VISTA CREEK DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7782
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Country | US
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Telephone | 917-531-7084
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12766
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License Number State | GA
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